Abdominoplasty before & after.

Abdominoplasty or "tummy tuck" is a cosmetic surgery procedure used to make the abdomen more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. This type of surgery is usually sought by patients with loose tissues after pregnancy or individuals with sagging after major weight loss.

Procedures[link]

Abdominoplasty operations vary in scope and are frequently subdivided into categories. Depending on the extent of the surgery, a complete abdominoplasty can take 1 to 5 hours. A partial abdominoplasty (Mini-Tuck Abdominoplasty) can be completed between 1 to 2 hours.

Reconstruction of the umbilicus (belly button) following an abdominoplasty surgery. The original umbilicus is sutured into a new hole created by the surgeon.

Complete abdominoplasty[link]

In general, a complete (or full) abdominoplasty follows these steps:

1. An incision is made from hip to hip just above the pubic area.
2. Another incision is made to free the navel from the surrounding skin.
3. The skin is detached from the abdominal wall to reveal the muscles and fascia to be tightened. The muscle fascia wall is tightened with sutures.
4. Liposuction is often used to refine the transition zones of the abdominal sculpture.
5. A dressing and sometimes a compression garment are applied and any excess fluid from the site is drained.

Full abdominoplasty consisting of musculofascial plication abdominal dermal lipectomy, suction-assisted lipectomy of hips.

Partial abdominoplasty[link]

A partial (or mini) abdominoplasty proceeds as follows:

1. A smaller incision is made.
2. The skin and fat of the lower abdomen are detached in a more limited fashion from the muscle fascia. The skin is stretched down and excess skin removed.
3. Sometimes the belly button stalk is divided from the muscle below and the belly button slid down lower on the abdominal wall.
4. Sometimes a portion of the abdominal muscle fascia wall is tightened.
5. Liposuction is often used to contour the transition zone.
6. The flap is stitched back into place.

The completely sutured area where nearly 100 square centimeters of skin was removed during a combination abdominoplasty and liposuction procedure (also known as a "lipo-tuck"). Note the "neo"-umbilicus (belly button) that was reattached to a newly created hole.

Extended abdominoplasty[link]

An extended abdominoplasty is a complete abdominoplasty plus a lateral thigh lift. The resulting scar runs from the posterior axillary line (when placing you open hands on your hips, the thumbs lie along the posterior axillary line.) The operation does all of the abdominal contouring of a complete abdominoplasty plus allows further improvement of the flank (waist), as well as smoothing the contour of the upper lateral thigh.

High lateral tension tummy tuck[link]

This is an advanced technique that takes a little more than four and half hours to perform. Conventional abdominoplasty tightens muscles in a vertical line. In this new method, known as high lateral tension abdominoplasty, in addition to vertical-line tightening, muscles are tightened horizontally. The final result with this technique is a dramatically flat abdomen with significantly better-defined waistline.

Circumferential abdominoplasty[link]

An circumferential abdominoplasty is an extended abdominoplasty plus a buttock lift. The resulting scar runs all the way around the body, and the operation is also called a Belt Lipectomy or Body Lift. This operation is most appropriate for patients who have undergone massive weight loss.

Combination procedures[link]

An abdominoplasty is a component of a lower body lift and can be combined with liposuction contouring, breast reduction, breast lift, or occasionally hysterectomy, depending on the reason for the hysterectomy. A popular name for breast enhancement procedures performed in conjunction with an abdominoplasty is a "mommy makeover". Recent literature in MEDLINE also has noted implementation of barbed suture in these procedures.

Recovery[link]

• Depends on the problem to be treated, surgical technique(s), and other factors. Can take one to four weeks and patients are advised to take at least a portion of this recovery time off from work.
• Heavy activity especially is best avoided during this time.
• Initially there may be bruising and discomfort.
• A supportive abdominal binder or compression garment can minimize swelling / bruising, and support the repaired tissues.
• Patients are advised to avoid all forms of nicotine for a month or longer prior to surgery and also during the recovery period.
• Full recovery takes 3 – 6 months, with further fading of scars thereafter.

Risks[link]

Abdominoplasty carries certain risks that may be serious or life-threatening. When taking the decision to undergo such a procedure it is recommended to compare the benefits with the potential risks and complications. Hence, all patients must be informed on all the risks they are exposing themselves to.

Abdominoplasty surgery is a cosmetic operation that is performed by a plastic surgeon to thin the abdominal region.

Although "tummy tucks" are considered safe procedures, as with any other type of surgery, different complications may arise. The majority of the risks can be avoided if the patients follow carefully the instructions they receive from their surgeon. Severe complications occur however in rare cases and these include blood clots, thrombosis, cardiac and pulmonary complications or infection.^[1]

Infection and blood clots are a serious potential risk after abdominoplasty, but which occur rarely. Infection is usually treated with antibiotics and drainage. Patients are recommended to move around as soon as possible after surgery to minimize their risks of developing blood clots. Pulmonary embolism, heart attack or stroke are very rare complications that may result after any type of surgery due to immobility after surgery which results in blood clots that may travel to the heart, lung or brain. Thus, pulmonary embolism is a serious risk after "tummy tuck" procedure and if they occur, they commonly happen within 3 weeks of the surgery, but more commonly within the first 72 hours after the procedure has been performed.^[2]

If complications occur, they usually delay the healing process. In rare cases, another surgery is needed to fix a potential complication. Skin necrosis is one of the complications that may require another procedure as the dead skin must be replaced by a skin graft. Although necrosis is extremely rare, smokers have an increased risk to develop skin necrosis. Stopping nicotine use and smoking several weeks before and several weeks after surgery cleans the body and improves the chance of an uneventful recovery.^[3]

One of the more common problems after an abdominoplasty is collection of fluid under the skin after the drains have been removed.A surgeon can aspirate the fluid with a needle. The drainage stops within a month and does not affect the final results.

The scars resulting from abdominoplasty are long, brutal in appearance, and permanent. The size of the scar depends on the amount of skin that has been cut-off, the techniques used for the surgery, the surgeon's skills, and the body's ability to recover.^[4] Although this scar will never become invisible, it is usually placed under the swimsuit line so it is covered by clothes. It normally takes 9 months to a year before scars flatten out and lighten in color.

Possible risks of abdominoplasty include:

• Bleeding
• Fluid accumulation
• Poor wound healing
• Skin loss
• Numbness or other changes in skin sensation
• Anesthesia complications
• Skin discoloration and/or prolonged swelling
• Fatty tissue found deep in the skin might die (fat necrosis)
• Major wound separation
• Asymmetry
• Recurrent looseness of skin
• Pain, which may persist
• Persistent swelling in the legs
• Nerve damage
• Possibility of revisional surgery
• Hematoma (may occur in 3 to 4% of cases)
• Keloid (heavy scar)
• Seroma
• Suture rupture
• Swelling
• Visible scar^[5]
• Death

Cost[link]

The cost of a "tummy tuck" varies from country to country and even within locales of countries. As with most cosmetic surgery operations, the cost depends on a variety of factors like the age of the patient, their weight and the state of their health. Depending on the individuals, there may also be other costs involved after the operation. This does not include the follow-up visits as required by some doctors.

In the United States this procedure can cost from USD$4,000 to as much as $20,000.

The pre-operative and post-operative care, facility fees, anesthesia, and medications must be taken into consideration when reviewing surgery costs. No surgeries are a guaranteed success and therefore a second procedure or a touch-up may be required to achieve the desired appearance. These costs are typically not included in the original cost.

Related procedures[link]

Liposuction, also known as lipoplasty, is a cosmetic surgical procedure that slims and reshapes specific areas of the body by removing excess fat deposits, improving the body's contours and proportion, and ultimately, enhancing the patient's self-image. Liposuction involves the use of a small stainless steel tube, called a cannula. The cannula is connected to a powerful suction pump and inserted into the fat through small incisions in the skin. Fat removal is accomplished as the suction cannula creates tiny tunnels through the fatty layers.^[6] Liposuction can be performed on both men and women. Ideal for this type of procedure are non-smokers, healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing, adults within 30% of their ideal weight who have firm and elastic skin.

Body contouring is a general term that refers to various plastic surgeries performed to different parts of the body with the aim of improving the shape and tone of the underlying tissue that supports fat. It is a common procedure performed for people who have undergone major weight loss. It may be performed in both men and women.

Breast reduction, or reduction mammoplasty, is the cosmetic surgery used in resizing the breast, in women with oversized breasts and men who suffer from gynecomastia. It is an overall safe procedure and most of the patients are pleased with the results.^[7] This type of surgery is performed to treat a breast condition known as hypertrophy, which refers to oversized breasts. This condition usually occurs in both breasts and commonly develops at puberty or immediately after.

Breast lift, also referred to as mastopexy, is the surgical procedure that removes the excess skin and tightens the surrounding tissue of the breast, resulting in raising and firming the breast. Mastopexies carry a certain degree of risks as any other type of surgery does. They are however safe procedures and the risks are minimized if the patients follow the surgeon's instructions.^{[citation needed]}

'Hysterectomies are sometimes performed with abdominoplasty. A hysterectomy consists in removing the uterus and it may be complete (when the body, fundus and cervix are removed) or partial (when only the uterine body is surgically removed). This procedure is normally performed by gynecologists and it is one of the most common gynecological surgeries. This type of surgery is used to treat some benign tumors, cancers of the ovaries, uterus or cervix, endometriosis and are also performed in transmen.

Image gallery[link]

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  Making the initial incision across the lower abdomen. The incision is placed in the bikini line and runs from hip to hip.

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  The final sutures securing the umbilicus (also known as "belly button") into its new position after an abdominoplasty.

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  The removal of nearly 100 square centimeters of skin from the abdomen of a 40-year old woman during an abdominoplasty surgery (also known as a "tummy tuck")

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  Placing the final sutures following an abdominoplasty procedure.

See also[link]

• Abdominal etching

References[link]